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Lookup NU author(s): Emeritus Professor Andrew Rugg-Gunn
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).Community water fluoridation (CWF) is one of the most significant public health programs targeting oral health. It has contributed to improving population oral health over the past 8 decades. As a public health program, CWF faces numerous evidentiary challenges. This review discusses 3 major controversies related to CWF’s evidence of effectiveness, safety, and approaches to its implementation. Scientific evidence of CWF’s effectiveness has been summarized. We discuss the need to expand the use of observational data to address the causal effects of fluoridation on dental caries by applying modern causal inference approaches. We present scientific evidence that CWF reduces socioeconomic inequalities in oral health, which has been inadequately acknowledged. The scientific evidence of the safety of established CWF programs worldwide, measured by indicators of child intellectual and behavioral development and executive functioning, is presented and discussed. The review provides consistent evidence to confirm CWF as an effective and safe public health program in preventing dental caries. The third controversy is related to the implementation approaches of CWF as a public health program. The connection between scientific evidence, health policy development, and the engagement of political and other actors in implementing policies to improve health is discussed. Different types of policy implementation are discussed. Maintenance and expansion of CWF as a public health program are needed to improve the population’s oral health. A strong collaboration among scientists, public health practitioners, and policymakers will be necessary to address the controversies associated with CWF and continue the implementation of this public health measure.
Author(s): Do LG, Ha DH, Spencer AJ, Rugg-Gunn A
Publication type: Review
Publication status: Published
Journal: Journal of Dental Research
Year: 2025
Pages: epub ahead of print
Online publication date: 30/11/2025
Acceptance date: 02/04/2018
ISSN (print): 0022-0345
ISSN (electronic): 1544-0591
Publisher: SAGE Publications Inc.
URL: https://doi.org/10.1177/00220345251394295
DOI: 10.1177/00220345251394295
